Management of focal nodular hyperplasia of the liver: Experience of 50 pediatric patients in a tertiary center

Zarfati, Angelo; Chambers, Greg; Pio, Luca; Guérin, Florent; Fouquet, Virginie; Franchi‐Abella, Stéphanie; Branchereau, Sophie

doi:10.1016/j.jpedsurg.2020.01.009

Cited by 25 publications

(24 citation statements)

References 33 publications

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“…Approximately two-thirds of liver tumors in pediatric patients are malignant, whereas FNH accounts for only 2–7% ( 1 ). Thus, the accuracy of diagnosis is of great importance when encountering a hepatic tumor in a child.…”

Section: Discussionmentioning

confidence: 99%

“…Focal nodular hyperplasia (FNH) is a clinically rare benign lesion of the liver that is especially uncommon in children, accounting for approximately 2-7% of pediatric liver tumors (1)(2)(3)(4)(5). There are reports of approximately 300 cases of FNH in children.…”

Section: Introductionmentioning

confidence: 99%

“…There are reports of approximately 300 cases of FNH in children. Although the exact etiology and mechanism of FNH remain unclear, the most widely accepted theory is that FNH develops from non-neoplastic hyperplasia of the hepatic parenchyma caused by hepatic vascular malformation or injury (1,(5)(6)(7). The main causes include anomalous aortic vascularization, secondary thrombosis, reactive hyperplasia after hepatocellular injury caused by vasculitis, or abnormal blood perfusion, involving either the portal veins or arteries (3).…”

Section: Introductionmentioning

confidence: 99%

“…Treatment options for FNH include open surgery, laparoscopic surgery, radiofrequency ablation (RFA), transarterial embolization (TAE), or conservative observation. According to related studies (1,4,(8)(9)(10)(11), the main reasons for clinical treatment are as follows: (i) unclear diagnosis; (ii) obvious symptoms; (iii) tumor larger than 5 cm or causing compression of adjacent organs; and (iv) tumor enlargement during follow-up. Due to its minimal invasiveness and reliable efficacy, percutaneous thermal ablation has gradually become more common for the treatment of FNH in adults, with satisfactory results.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Ultrasound-Guided Percutaneous Microwave Ablation of Focal Nodular Hyperplasia in a 9-Year-Old Girl

et al. 2021

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Focal nodular hyperplasia (FNH) is a rare benign tumor-like space-occupying lesion of the liver that is especially rare in children. Since there have been no reports of malignant progression of this disease and these lesions remain unchanged for a long period of time or even disappear in some cases, it remains controversial whether clinical treatment is needed. However, if the diagnosis is unclear, the patient has symptoms or the lesion becomes enlarged during follow-up, clinical treatment should be considered. Here, we report the first case of FNH near the gallbladder treated by ultrasound-guided percutaneous microwave ablation (MWA) in a 9-year-old girl.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report: Ultrasound-Guided Percutaneous Microwave Ablation of Focal Nodular Hyperplasia in a 9-Year-Old Girl

et al. 2021

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“…According to the literature, a minority of pediatric cancer survivors undergo surgery in cases with complications, symptoms, and marked tumor growth [18,19]. For example, Zarfati et al [20] suggested that a negligible change in the size of FNHs should not be considered a surgical indication, if the change does not cause symptoms, because the clinical outcomes do not differ significantly between surgery and observation in patients with growing FNHs. We recommend investigation of the therapeutic risk and benefit ratio of FNH-like lesions in pediatric cancer survivors, while keeping in mind that a wait-and-see strategy may often be the most appropriate choice.…”

Section: Discussionmentioning

confidence: 99%

Gd-EOB-DTPA MRI for focal nodular hyperplasia-like lesions in pediatric cancer survivors

Jeon

Yoo

et al. 2020

Eur Radiol

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Objectives To investigate the hepatobiliary enhancement patterns of gadoxetic acid (Gd-EOB-DTPA) MRI and the temporal evolution of focal nodular hyperplasia (FNH)-like lesions in pediatric cancer survivors. Methods We retrospectively included pediatric cancer survivors who had new liver lesions detected during surveillance imaging and who were diagnosed with FNH-like lesions by Gd-EOB-DTPA MRI without the aid of a hepatobiliary phase. The hepatobiliary enhancement patterns of FNH-like lesions were categorized as homogeneous hyperintense/isointense, heterogeneous hyperintense, and ring-like enhancement. Temporal changes in the FNH-like lesions were evaluated by follow-up Gd-EOB-DTPA MRI. Statistical analyses included one-way analysis of variance and Spearman's rank correlation test. Results A total of 132 radiologically diagnosed FNH-like lesions in 18 patients showed the three different hepatobiliary enhancement patterns: homogeneous hyperintense/isointense (n = 65, 49%), heterogeneous hyperintense (n = 24, 18%), and ringlike enhancement (n = 43, 33%). A weak positive correlation was found between the lesion size and the hepatobiliary enhancement pattern (p = 0.015). Follow-up MRI showed alterations in the size and number of 55 FNHs in 8 patients, including stable size (n = 15, 27%), increased size (n = 17, 31%), decreased size (n = 11, 20%), disappearance (n = 12, 22%), and 74 new lesions (5 patients, 63%). Conclusions FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns and various temporal changes. Recognition of the radiological characteristics of FNH-like lesions may avoid unnecessary invasive procedures and reduce patients/parents' anxiety. Key Points• FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns. The most common was homogeneous hyperintense/isointense, followed by heterogeneous hyperintense, and ring-like enhancement. • FNH-like lesions in pediatric cancer survivors can show various temporal changes during follow-up. Keywords Focal nodular hyperplasia . Magnetic resonance imaging . Gadolinium ethoxybenzyl DTPA . Cancer survivors Abbreviations DWI Diffusion-weighted images FDA Food and Drug Administration FNH Focal nodular hyperplasia Gd-EOB-DTPA Gadoxetic acid HBP Hepatobiliary phase OATP1B3 Organic anion-transporting polypeptide 1B3 T1WI T1-weighted images T2WI T2-weighted images * Tae Yeon Jeon

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Vascular Disorders of the Liver

Bruyne

2021

Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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Management of focal nodular hyperplasia of the liver: Experience of 50 pediatric patients in a tertiary center

Cited by 25 publications

References 33 publications

Case Report: Ultrasound-Guided Percutaneous Microwave Ablation of Focal Nodular Hyperplasia in a 9-Year-Old Girl

Case Report: Ultrasound-Guided Percutaneous Microwave Ablation of Focal Nodular Hyperplasia in a 9-Year-Old Girl

Gd-EOB-DTPA MRI for focal nodular hyperplasia-like lesions in pediatric cancer survivors

Vascular Disorders of the Liver

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